Licence Appeal Tribunal File Number: 16643/MED

An appeal under subsection 50(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8, from a decision of the Minister of Transportation to downgrade a licence pursuant to Section 32(5)(b)(i) of the Act.

Between:

Harold Horn

Appellant

and

Minister of Transportation

Respondent

DECISION

ADJUDICATOR: Dr. Isla McPherson, Member

APPEARANCES:

For the Appellant: Harold Horn, Appellant

For the Respondent: Stephen Grootenboer, Agent

Held by teleconference: February 26, 2025

OVERVIEW

1Harold Horn (the “appellant”) appeals from the decision of the Minister of Transportation (“Minister”) to downgrade his Class B licence under s. 32(5)(b)(i) of the Highway Traffic Act, R.S.O. 1990, c. H.8 (the “Act”) after the Minister received a Medical Report stating that the appellant suffers from a medical condition that may affect his ability to drive a vehicle of the applicable class safely.

2Section 14(1)(a) of O. Reg. 340/94 under the Act (the “Regulation”) states that a holder of a driver’s licence must not suffer from any mental, emotional, nervous or physical condition or disability likely to significantly interfere with their ability to safely drive a motor vehicle of the applicable class safely. Under s. 14(2)(b) of the Regulation, the Minister of Transportation may require a driver to provide satisfactory evidence that they are able to drive safely.

3Section 32(5)(b)(i) of the Act states that the Minister may impose the conditions authorized by the regulations, remove any conditions or endorsements or change the class or classes of driver’s licence held by the person, in accordance with the results of the examinations and other prescribed requirements.

4The Minister takes the position that the appellant suffers from a medical condition, namely syncope, that is likely to significantly interfere with his ability to drive a commercial vehicle safely and that this provides sufficient reason to downgrade his licence under s. 32(5)(b)(i) of the Act.

5The appellant appeals the downgrade under s. 50(1) of the Act. While he agrees that he suffered from a single episode of syncope, he denies that he suffers from a medical condition which interferes with his ability to drive a commercial vehicle safely.

6Pursuant to section 50(2) of the Act, after a hearing the Tribunal may confirm, modify, or set aside the decision or order of the Minister.

ISSUES

7The issue in this appeal is whether the appellant suffers from a medical condition that is likely to significantly interfere with his ability to drive a commercial vehicle safely.

8To resolve that issue, I will address the following questions:

i. Does the appellant suffer from syncope?

ii. If so, is this likely to significantly interfere with his ability to drive a commercial vehicle safely?

9The Minister bears the burden of proving on a balance of probabilities that the answer to each of the above questions is “yes.”

RESULT

10Having considered all the evidence and submissions and for the reasons that follow, I find that the Minister has satisfied its burden to establish that the appellant suffers from a medical condition that is likely to significantly interfere with his ability to drive a commercial vehicle safely and I confirm the Minister’s decision to downgrade the appellant’s driver’s licence.

ANALYSIS

Does the appellant suffer from syncope?

11The evidence presented at the hearing establishes that the appellant suffers from a medical condition, namely syncope.

12The Minister’s position is supported by:

i. a Medical Report dated August 28, 2024, from Dr. S;

ii. a Cardiologist Consultation Report by Dr. C dated July 30, 2024; and

iii. a Seizure and Loss of Consciousness Form dated January 28, 2025, from Dr. S.

13The appellant’s family physician, Dr. S, submitted a Medical Report indicating that the appellant suffered from a syncopal episode on July 4, 2024, and included a cardiology consultation report from Dr. C.

14Dr. C’s consultation report indicated the appellant suffered from an episode of syncope on July 4, 2024, and the etiology of this episode remained unclear, but was possibly vasovagal. Cardiac investigations did not demonstrate any significant abnormality and no further follow up was planned.

15Following receipt of the Medical Report form, the Minister downgraded the appellant’s B class licence to a G class licence effective September 10, 2024, and requested the completion of a Seizure and Loss of Consciousness Form.

16The requested Seizure and Loss of Consciousness Form was completed by Dr. S on January 28, 2025. Dr. S checked two boxes, one indicating that the appellant suffered from atypical vasovagal syncope (i.e. occurs in the sitting position or is not preceded by warning signs but is still diagnosed as vasovagal syncope) and a second box indicating the appellant suffered from unexplained syncope. Dr. S left a narrative note that the syncopal episode had occurred once, and the treating cardiologist had documented “possibly vasovagal”; the appellant’s hematologist documented “he may have experienced a vasovagal episode” and the history sounded likely to be a vasovagal episode.

17The Minister’s position is that the appellant suffered from an episode of atypical vasovagal syncope / unexplained syncope as indicated in the Seizure and Loss of Consciousness Form completed by Dr. S.

18The appellant testified that, on July 4, 2024, it had been a hot day and after cutting the lawn wearing coveralls, he sat down on his porch to have his wife change his wound dressings on both his ears. He had both ears biopsied, and one ear had required a skin graft. During the changing of the second dressing, he described experiencing discomfort and a sense of anxiety about the dressing change. This was followed by suddenly feeling unwell, and then the appellant lost consciousness. When he awoke, he was on the floor. He had no memory of how he arrived at being on the floor.

19The appellant’s wife testified that while she was changing her husband’s dressing, he expressed a feeling of being unwell and lost all colour in his face. She and her son-in-law then assisted her husband to lay down on the ground. In the process of moving the appellant, he lost consciousness. She testified he was breathing and mumbling but not responsive, and paramedics were called. The appellant regained consciousness a few minutes later following a sternal rub from his wife.

20The appellant testified that when EMS arrived and assessed him, they determined that their investigations were unremarkable. The appellant reported that as he was feeling much better, he declined being transferred to the hospital.

21The following day, July 5, 2024, the appellant had a pre-existing appointment with his hematologist Dr. D, who he follows up with for a blood cancer. During this appointment he recounted the incident, and Dr. D conducted an EKG and referred him to an urgent cardiology clinic where he subsequently saw Dr. C on July 9 and 30, 2024. He underwent investigations with an echocardiogram, Holter monitor and exercise stress test which were unremarkable.

22Both the appellant and his wife testified to an incident in 2022 where he presented similarly with a sudden and unexpected loss of consciousness. During this episode, his wife testified she was required to perform CPR while awaiting paramedics. Upon transfer to hospital all investigations were reportedly normal, and the incident was attributed to a delayed anaphylactic response to a wasp sting.

23The medical evidence before the Tribunal includes documents from Dr. S and Dr. C who both confirm the appellant has suffered from syncope. The testimony of the appellant and his wife both confirm an episode of syncope.

24I find the medical evidence in this case relevant and persuasive and the diagnosis of syncope not in dispute. Based on the evidence before me, I find that the Minister has established on a balance of probabilities that the appellant suffers from syncope.

Is the appellant’s medical condition likely to significantly interfere with his ability to drive a commercial motor vehicle safely?

25I find that the Minister has proven on a balance of probabilities that the appellant’s medical condition is likely to significantly interfere with his ability to drive a commercial vehicle safely.

26The Minister argues that the appellant’s syncope interferes with his ability to drive a commercial vehicle safely and relies on the Canadian Council of Motor Transport Administrators Medical Standards for Drivers [February 2021] (the “CCMTA Standards”). Chapter 19 of the CCMTA Standards indicates that syncope causes an episodic impairment of all the functions necessary for driving and, as such, the driver cannot compensate in case of an episode.

27The CCMTA Standards’ guidelines for assessing syncope and corresponding waiting periods, are based on many factors including: whether the driver is a non-commercial or commercial driver; the number of syncopal episodes; the type of syncope; the position in which syncope occurs; whether the syncopal episode has treatable, reversible, or avoidable triggers; whether the syncopal episode is due to documented/inducible tachyarrhythmias; and whether the syncopal episode is unexplained. Furthermore, the syncope standards outline that waiting periods may be modified based on individual factors such as length of any reliable warning symptom or prodrome.

28The Minister’s agent argued that Dr. S has confirmed that the appellant has suffered an episode of atypical vasovagal syncope / unexplained syncope. Atypical syncope is syncope that occurs in the sitting position or is not preceded by warning signs that are sufficient to allow a driver to pull off the road before losing consciousness. Given the risk of sudden incapacitation associated with this medical condition without any ability to compensate including even enough notice to pull off the side of the road, it is prudent for road safety to ensure that enough time has elapsed that it is unlikely further episodes would occur.

29The Minister’s agent referred to CCMTA Standard 19.6.10 which states that commercial drivers with single or recurrent atypical vasovagal syncope or unexplained syncope would be eligible for a licence if:

i. It has been at least 12 months since the last episode of syncope, and

ii. The conditions for maintaining a licence are met.

30Section 14(2)(a) of the Regulation allows the Minister to consider the CCMTA Standards when determining whether the requirements of s. 14(1) are met. The Tribunal may take the CCMTA Standards into consideration but is not bound by them.

31The appellant argued that while he respects the Minister’s position, his case is not black and white, and his condition will not interfere with his ability to drive a commercial vehicle safely.

32The appellant testified that with the exception of an anaphylactic reaction in 2022 and the syncope episode on July 4th, 2024, there have been no other incidents. He testified that he believes the anxiety related to the discomfort of the dressing change caused the episode of syncope. The appellant added that he has undergone many dressing changes before and after this episode without feeling unwell, and this episode was a “one off”. The appellant also testified he has been “cleared” by Dr. S, Dr. C and his hematologist Dr. D, there were no concerns with his cardiology investigations, and no further cardiology follow up required.

33The appellant further testified that the Minister’s submissions describing categories of syncope under the CCMTA standards describes a single episode of typical vasovagal syncope as requiring no restriction on a commercial driver’s licence. The appellant testified he feels this best describes his episode of syncope. He reported that in his discussion with Dr. S, Dr. S was surprised that his commercial licence had been downgraded.

34Under cross-examination, the appellant testified that following the case conference, he had reached out to Dr. S to request an amendment to the Seizure and Loss of Consciousness form to reflect that this was a single isolated episode of typical vasovagal syncope. The appellant left a message with Dr. S’s office administrator requesting that Dr. S amend the form. However, Dr. S did not amend the form and instead resubmitted the same Seizure and Loss of Consciousness form to the Minister. The appellant testified he has not followed up with Dr. S as his office had limited appointment times and billed the appellant for every form completed.

35The appellant testified that he was also likely not drinking enough fluids that day. Under cross-examination he testified he had a good appetite and had been eating well leading up to the episode, had no vomiting or diarrhea, had not consumed any alcohol, and felt well that day prior to the event occurring.

36The appellant’s wife testified that she felt that dehydration had precipitated the episode of syncope as it was a hot day and the appellant had been cutting the grass, and even though he was on a riding mower it would have been hot as he was wearing coveralls. She further testified that the paramedics had suggested the episode was due to heatstroke.

37Under cross-examination the appellant testified that after discussing the episode with Dr. C, Dr. S and Dr. D, he had not been prescribed any treatments or given any lifestyle recommendations for preventing any further episodes of syncope.

38The appellant testified that he drives a school bus 10-20 hours per week and has been driving a van on occasion with his G class licence since the downgrade. He submits that he is safe to operate a school bus again with a Class B licence.

39The respondent’s agent submitted that there is no medical evidence to support the appellant’s position that his syncopal episode was caused by either the dressing change, dehydration, or heatstroke. The Minister’s agent also submitted that it is not under dispute that the appellant suffered an episode of syncope while in the seated position which is consistent with atypical vasovagal syncope. Further, there is no medical evidence that the appellant’s physicians are supportive of returning to commercial driving. The respondent’s agent submitted that the Minister does not take this decision to downgrade the appellant’s licence lightly, but has a duty to protect all road users and if a collision resulted from the appellant driving a commercial vehicle the results could be disastrous. The respondent’s agent submitted that the Minister’s position is reasonable, prudent for road safety and inline with the applicable law and CCMTA Standards.

40While I appreciate the appellant has indicated that there may be several causes of his syncopal episode, I agree with the respondent’s agent that none of them are supported by the medical evidence presented, despite the appellant’s request to Dr. S to amend the Seizure and Loss of Consciousness form which documents the appellant suffered an episode of atypical vasovagal and unexplained syncope. Moreover, the appellant’s claim that his syncopal episode was caused by the anxiety of a dressing change is inconsistent with the medical evidence form Dr. C. Dr. C has documented in his consultation report, “the [syncopal] event occurred the previous night as wife was chang[ing] dressings on his ears…which has been done before and is not considered a stressful event”.

41Furthermore, I note that the CCMTA Standards define typical vasovagal syncope as, “a vasovagal syncope that occurs when standing and is preceded by warning signs that are sufficient to allow a driver to pull off the road before losing consciousness”. Both the appellant and his wife have testified that the event occurred while in the seated position without sufficient notice for the appellant to lower himself to the ground, which fits the definition of atypical vasovagal syncope. As such, I agree with the Minister’s position that the medical evidence and testimony of the appellant and his witness align with CCMTA Standard 19.6.10 addressing single or recurrent atypical vasovagal syncope or unexplained syncope.

42I also give weight to the appellant’s evidence that he was given no treatment recommendations from his physicians to avoid another occurrence of syncope. In the absence of a clearly identified reversible cause of the appellant’s syncope, there is no way to intervene to reduce the likelihood of future events. For these reasons, I conclude that a waiting period to ensure recurrence is unlikely is reasonable. I note that the CCTMA Standards request 12 months episode free. At the time of the hearing, only half of the suggested time has elapsed since the episode occurred.

43I acknowledge the appellant’s position that he is driving with a G class licence safely at present, and that he feels that driving with a commercial licence poses no additional risk to road safety. I understand the CCMTA Standards for commercial drivers requires a higher level of fitness than those who operate G class vehicles (i.e., passenger cars). I understand that this difference in the standard may be significant to the appellant, but I disagree that there is no additional risk to road safety when operating a commercial vehicle. I believe that the standard for driving a commercial vehicle is higher for the reasons that these drivers spend many more hours driving, often drive under far more adverse conditions, are often unable to select their hours of work, cannot readily abandon their cargo should they become unwell on duty, and lastly because should the commercial driver suffer a collision, the consequences are much more likely to be serious. Should the appellant suffer from sudden incapacitation with no ability to compensate while driving, it is not difficult to understand how the consequences could be disastrous for both the driver and passengers of a school bus as well as other road users.

44Lastly, I note that while the appellant argued that he has been “cleared” by all of his treating physicians, there is no medical evidence provided that any healthcare practitioner supports the reinstatement of a commercial driver’s licence.

45Although I recognize that I am not bound by the CCMTA Standards, I considered them in light of the appellant’s individual circumstances when making the decision because they are the result of a lengthy and intensive process to provide medical standards based on the best evidence available and with a focus on functional ability to drive rather than exclusively on medical diagnoses. My review of the evidence shows that the conditions recommended for relicensing outlined in the CCMTA Standards have not been met. I conclude that it is appropriate for me to apply them in this case.

46I acknowledge the burden the lack of a commercial driver’s licence is having on the appellant. However, only half of the episode-free timeframe recommended has passed, and the lack of any submitted medical evidence to support the safety of driving with this condition, is concerning.

47As such, for the reasons cited, I am satisfied on a balance of probabilities that the appellant’s medical condition is likely to significantly interfere with his ability to drive a commercial vehicle safely.

CONCLUSION

48I find that the Minister has discharged the onus of establishing on a balance of probabilities that the appellant suffers from a medical condition, namely syncope, which is likely to significantly interfere with his ability to drive a commercial vehicle safely.

ORDER

49For the reasons set out above, pursuant to subsection 50(2) of the Act, I confirm the Minister’s decision to downgrade the appellant’s driver’s licence.